Regenerative Periodontal Surgery

Question 1

What is regeneration?

Answer 1

Goal of perio surgery - Stop progression of disease by formation of a long junctional epithelium
More idealistic goal - restore structure and function of lost periodontal tissues (root cementum, PDL, AB, CT attachment)
Regeneration - only in vertical defects

Question 2

Regenerative techniques?

Answer 2

Bone substitutes
Guided tissue regeneration
Growth factors and biologicals
Grafting and combined therapies

Question 3

Use of bone substitutes - what do they do?

Answer 3

Bone forming cells - osteogenesis
Serve as scaffold - osteoconduction
Contains bone inducing substances - osteoinduction

Question 4

Types of bone substitutes?

Answer 4

Bone autogenous
Bone allografts
Bone xenograft (bio-oss)
Bone alloplastic materials - hydroxyapatitis and bioactive glasses

Question 5

What does Bio-oss do?

Answer 5

1. Clot stabilisation facilitated by bio-oss interconnecting macro and micropores
2. Revascularisation, migration of osteoblasts and in-growth of woven bone is enhanced by bio-oss scaffolding
3. Labellar bone and bio-oss are successfully integrated after 6 months.

Question 6

Bioglass technology - how does it work?

Answer 6

Attracts organic molecules and own body’s building tissues for tissue regeneration = these are bonded

Question 7

How does guided tissue regeneration work?

Answer 7

Used for the prevention of epithelial migration along the cemental wall of the pocket and maintaining space for clot stabilisation
Placing a membrane barrier to cover the bone and PDL = temporarily separating them from the gingival epithelium and CT
= Prevents epithelial migration and favours repopulation of area by cells from PL and bone

Epithelial tissue develops faster than CT
Membrane forms a barrier = prevents down growth of epithelium
CT then has change to develop further into the defect
Most biodegradable membranes e.g. bioguide

Question 8

Growth factors and biologicals - what does an enamel matrix derivative do (Emdogain)?

Answer 8

Stimulates amelogenin production and biological action
Secrete enamel matrix proteins, cementoblasts produce cementum

After placing emdogaingel:

1. Attraction
2. Attachment and proliferation
3. Differentiation
4. Alveolar bone formation

Question 9

Evidence for emdogaingel treatment?

Answer 9

87 percent of sites >2mm attachment gain
Majority of sites >4mm attachment gain
Average bone fill 69%
Emdogain = predictable way to enhance periodontal regeneration outcome

Can also provide soft tissue root coverage alongside a coronally advanced flap
- Average root coverage 73%

Question 10

How to apply emdogain?

Answer 10

Coronally advanced flap
Root surface conditioning with PrefGel
Application emdogain
Barricaid periodontal dressing
Maintenance care